General Surgery Coding Alert

Watch for routine services and count the extra reimbursement

When your general surgeon removes a patient's gall bladder, you should make sure all of his efforts are being rewarded.

Here's how: With a laparoscopic (47562-47564) or open (47600-47610) cholecystectomy, you should watch out for two common procedures that go along with them: cholangiography and exploration of the common bile duct.

If the surgeon performs a cholangiography, you can bill 47563 for a cholecystectomy with cholangiography. Or for an open procedure, you can bill 47605. If you bill 47563 instead of 47562, your surgeon will receive an extra $20, which can add up over time.

And if your surgeon explores the common bile duct, you should bill 47564 (... with exploration of common duct), or 47610 for the open procedure. Typically, 47564 pays about $120 more than 47562.

The surgeon will often need to perform a cholangio-graphy to make sure there are no gallstones in the cystic duct or common bile duct, says M. Trayser Dunaway, MD, a surgeon, coding educator and healthcare consultant in Camden, S.C.

Also, the surgeon will use a cholangiogram to define the patient's anatomy because sometimes the patient's cystic duct will empty into the right hepatic duct instead of the common bile duct.

Watch out: Even if she performs cholangiography, the surgeon may forget to document it because the procedure is so routine, says Arlene Morrow, CPC, CMM, CMSCS, a coding specialist and consultant with AM Associates in Tampa, Fla. When in doubt, ask the surgeon for direction.

Increasingly, surgeons will send a patient to a gastrointestinal (GI) physician for a less-invasive endoscopic retrograde cholangiopancreatography (ERCP) instead of performing a common duct exploration, Dunaway says. But if there's some reason the GI physician can't perform the ERCP, the surgeon may have to explore the common duct himself.

Common duct explorations are more likely to be open procedures, so if your surgeon performed an open cholecystectomy, you should check to see if he explored the common bile duct.

More revenue-boosters to watch for: Sometimes the surgeon will also take a liver biopsy along with a chole-cystectomy, Morrow says, and this could provide another separate coding opportunity. Some non-Medicare payers may also pay separately for fluoroscopy with chole-cystectomy, so check your insurance plans, she says.